Late Effects After Haematopoietic Stem Cell Transplantation in ALL, Long-Term Follow-Up and Transition: A Step Into Adult Life

Abstract

Haematopoietic stem cell transplant (HSCT) can be a curative treatment for children and adolescents with very-high-risk acute lymphoblastic leukaemia (ALL). Improvements in supportive care and transplant techniques have led to increasing numbers of long-term survivors worldwide. However, conditioning regimens as well as transplant-related complications are associated with severe sequelae, impacting patients' quality of life. It is widely recognised that paediatric HSCT survivors must have timely access to life-long care and surveillance in order to prevent, ameliorate and manage all possible adverse late effects of HSCT. This is fundamentally important because it can both prevent ill health and optimise the quality and experience of survival following HSCT. Furthermore, it reduces the impact of preventable chronic illness on already under-resourced health services. In addition to late effects, survivors of paediatric ALL also have to deal with unique challenges associated with transition to adult services. In this review, we: (1) provide an overview of the potential late effects following HSCT for ALL in childhood and adolescence; (2) focus on the unique challenges of transition from paediatric care to adult services; and (3) provide a framework for long-term surveillance and medical care for survivors of paediatric ALL who have undergone HSCT.

Therapeutic Drug Monitoring of Conditioning Agents in Pediatric Allogeneic Stem Cell Transplantation; Where do We Stand?

“…Complications related to toxicity of the conditioning regimen are still a major cause of transplant-related mortality (TRM). Besides the risk of acute toxicity, late toxicities, such as infertility, are also a major problem ( Diesch-Furlanetto et al, 2021 ). One of the main challenges to improve HSCT outcome is reducing toxicity caused by the conditioning regimen while maintaining efficacy.…”

Clinical efficacy analysis of paxlovid in children with hematological diseases infected with the omicron SARS-CoV-2 new variant

“…Children infected with the novel coronavirus rarely progress to severe pneumonia, and their symptoms are milder than adults (17). This may be due to children's stronger innate immunity, which can better clear the virus, while adaptive immunity is weaker, and the inflammatory immune response is milder and other factors (18). Children with hematological tumors or after hematopoietic stem cell transplantation and receiving large doses of chemotherapy drugs and hormones have low immunity, 21).…”

“…This may be due to children's stronger innate immunity, which can better clear the virus, while adaptive immunity is weaker, and the inflammatory immune response is milder and other factors ( 18 ). Children with hematological tumors or after hematopoietic stem cell transplantation and receiving large doses of chemotherapy drugs and hormones have low immunity, decreased ability to clear respiratory secretions, and significantly increased risk of upper respiratory tract and lung infections ( 19 – 21 ). A study of 131 children with tumors and hematopoietic stem cell transplantation infected with the novel coronavirus proved that comorbidities, other infections, and neutrophil deficiency were significantly associated with increased disease severity ( 21 ).…”

Optimised conformal total body irradiation: a heterogeneous practice, so where next?

“… 63 The risk of premature death following haemopoietic stem cell transplant (HSCT) carries a 2.3-fold increased risk due to cardiovascular complications compared to healthy individuals (including TBI). 64 Cardiac doses can be reduced even when using conventional shielding, as highlighted in a recent paper by Glenn et al, 65 although 3D optimisation could take this further. Paix et al 18 state that HT for TMI vs conventional TBI provides a mean dose reduction of between 46 and 47%.…”